The development of the medical laboratory system
in Vietnam derived from knowledge and experience
from the Far East Medical Research Unit attached
to the 406th Medical General Laboratory in Japan,
the U.S. Army Medical Research Unit (Malaya),
the U.S. Component of the SEATO Medical Laboratory
in Bangkok, and the Field Medical Laboratory
Project, USARMDC. The system was based on a concept
of the laboratory as a component of medical service,
with a specific function of generating medical
technical information for the purpose of patient
care, disease prevention, advice to the, command,
and forensic activity.

The first medical laboratory unit in Vietnam, a mobile detachment of
the 406th Medical General Laboratory, began operations as laboratory augmentation
of the 8th Field Hospital in Nha Trang in 1962.

In late 1965, the 528th and 946th Mobile Laboratories of the 9th Medical
Laboratory arrived in Vietnam and were placed under operational control
of the 406th Mobile Laboratory. These units were to support the 85th and
93d Evacuation Hospitals. Within 6 months, the headquarters and base section
of the 9th Medical Laboratory arrived and assumed control over these units.
In August 1967, the 406th Mobile Laboratory was placed under operational
control of the 9th Medical Laboratory.

In January 1968, the 74th Medical Laboratory was activated and organized
to replace the 406th Medical Laboratory (Mobile) and was placed under operational
control of the 9th Medical Laboratory. By September 1968, the 946th and
528th Medical Laboratories (Mobile) were, inactivated and their personnel
assigned to the 9th Medical Laboratory. These two mobile laboratories,
or mobile sections of the 9th Medical Laboratory, continued operations
in Long Binh and Qui Nhon.

The 9th Medical Laboratory

From May to December 1966, the 9th Medical Laboratory was assigned to
the 44th Medical Brigade under the 1st Logistical Command. The equipment
was antique, and efforts to obtain new equipment and supplies were unrewarding.
Building facilities, located 15 feet from a dirt

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highway, were inappropriate and inadequate. As a result, little productive
work was accomplished considering the high potential of the personnel.
In December 1966, the laboratory moved from the small dusty store to a
newer building, a Vietnamese constructed barracks. Although the building
was larger, the site was less favorable.

In June 1967, authorities decided to construct
new facilities for the central laboratories at
Long Binh for the purpose of establishing more
appropriate buildings, bringing the 9th Medical
Laboratory and the 20th Preventive Medicine Unit
together for more coordinated function, bringing
the 9th Medical Laboratory in close support of
major hospitals at Long Binh to free a mobile
laboratory for service elsewhere, and bringing
the 9th Medical Laboratory in close range of
its supply and personnel support units. It was
not until December 1968, however, that, the laboratory
moved into its new fixed facilities, but not
before it had been exposed to hostile fire and
isolated twice earlier that year.

The 44th Medical Brigade was transferred from 1st Logistical Command
to the Surgeon, USARV, in 1967. After this transfer, a set of equipment
and supplies, developed by a USAMRDC contract, was ordered from manufacturers
in sufficient quantities to provide for all medical laboratory services
within the 44th Medical Brigade.

In his role as USARV pathology consultant, Colonel. Baker recommended
assignments of all medical laboratory personnel within the 44th Medical
Brigade, after their initial 2-week period of special training in the base
laboratory in Saigon. (Chart 14)

Innovations

An innovation in staffing that produced outstanding results in 1968
was the assignment of an internist to the laboratory staff to head an infectious
diseases department. In the 6-month period after the internist arrived,
the output of diagnostic information in febrile cases more than doubled.
In 1968, 29,160 diagnostic serology procedures were performed.

Veterinary laboratory officers played an important role in Vietnam.
They tested ice for chlorination potability and developed serologic methods
for diagnosis of melioidosis, leptospirosis, scrub typhus, and murine typhus.

The thrust of medical zoology in the laboratory system, was for quality
control, mainly in laboratory diagnosis of malaria and amebiasis. The malaria
smears reviewed by the laboratory increased each year, from 1965 to 1969,
as follows: 1965, 300; 1966, 1,199; 1967, 3,312; and 1968, 8,176. This
review for quality of smear, staining, and identification of parasites
was returned to each unit submitting smears, so that any deficient technique
could be recognized. Where needed, special visits by central laboratory
personnel were made. Similarly, materials

were provided to hospital laboratories to make trichrome stains of all
stool specimens considered positive for amebic dysentery. Some specimens
were submitted for review and diagnosis confirmed. The procedure for confirmation
was cause for greater care, on the part of technicians in field units.

Problems Surmounted

Under supervision of the base laboratory, advanced laboratory procedures
were established for hospitals, carrying major Surgical loads where advanced
intensive postoperative care was practiced. Because hospital facilities
were widely scattered, with restricted land communication between them
and a base laboratory and with a strictly limited number of laboratory
personnel available, it was imperative that the chemistry procedures provided
be essential for clinical decisions and be performed competently in forward
areas.

By late 1967, surgeons recognized that advanced laboratory methodology
provided information on the condition of their patients which challenged
their knowledge and prior experience. Similarly, the opportunity for Army
physicians to establish definitive etiological diagnoses on

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eight febrile diseases, being encountered for the first time in their
careers, was not only a benefit to the patients but also a positive factor
in professional morale.

The base laboratory maintained a courier system for specimens and reports
between dispensaries, some clearing, companies, all hospitals, and the
9th Medical Laboratory. Despite its imperfections, the courier system operated
by virtue of the determination of the couriers. After 1968, couriers were
helped in part by access to the Otter aircraft assigned to the 44th Medical
Brigade.

An automatic data processing system was established to retrieve disease
information by place and time. By late 1968, weekly summaries of etiological
diagnostic findings in febrile disease were prepared by computer and distributed
to all hospitals, preventive medicine units, and division surgeons. The
summaries gave the patient's name, identification number, and unit information
which was necessary since patients often remained only a short time in
facilities where the working diagnosis and treatment were initiated. Routine
laboratory reports were often returned to the hospital after discharge
of patients and went into their records without notice of the attending
physician. The weekly summary was an attention-catching mechanism that
allowed the physicians to review cases with specific findings for educational
benefits on diseases occurring in Vietnam. This information served also
for the purposes of disease prevention and advice for continuing military
operations.

By 1968, the medical laboratory system had largely
matured, It provided advanced technology where
it was needed with a limited number of skilled
persons strategically placed. Many persons with
special skills were regularly called upon to
assist in solving unusual problems. Each area
pathologist was either assigned to, or closely
associated with, the 9th Medical Laboratory.

The greatest need for pathologists was in supervising clinical pathology,
in managing the flow of work within the laboratory, and at times even in
maintaining advanced equipment. However, the most important role of the
pathologist was in his relation with clinicians in understanding the nature
of illness and trauma and in assuring that the most appropriate specimens
reached the laboratories. A pathologist in the base laboratory was assigned
the task of supervising clinical pathology throughout the 44th Medical
Brigade laboratories to assure standardization of methodology.

Anatomic pathology required fewer pathologists. The greatest and most
essential workload in anatomic pathology was the forensic cases. A large
workload of interest to the pathologists was the surgical pathology on
biopsies submitted by volunteer surgical teams working, with the indigenous
population, Since provision was made for frozen sections in

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the larger military hospitals, the processing of paraffin sections and
their reading was centralized in Saigon.

The medical laboratory service in Vietnam finally
reached a high level of quality service after
several years. By 1970, as a result of coordination
between the medical laboratory system and preventive
medicine, a level of effectiveness comparable
to that in World War II had been achieved. The
primary failure had been an inordinate delay
in bringing about a close coordination between
the medical laboratory system and the preventive
medicine units. Since both activities were an
integral part of the laboratory system, this
had not been a problem in World War II.